1/26. L-tryptophan syndrome: histologic features of scleroderma-like skin changes.The eosinophilia-myalgia syndrome (EMS) associated with the ingestion of L-tryptophan (LT) containing products has recently been recognized in the United States. We report the histologic features of the cutaneous scleroderma-like changes in four patients. All of the patients met the Center for disease Control criteria for EMS and had a history of LT ingestion. skin biopsies showed increased dermal mucin and dermal sclerosis, with trapping of adnexal structures. There are clinical and histologic similarities between EMS, scleroderma, the toxic oil syndrome, and fasciitis with eosinophils.- - - - - - - - - - ranking = 1keywords = eosinophilia-myalgia syndrome, eosinophilia-myalgia (Clic here for more details about this article) |
2/26. L-tryptophan-induced eosinophilia-myalgia syndrome.This report describes three Belgian cases of the eosinophilia-myalgia syndrome associated with the use of L-tryptophan-containing products. Three women, aged 51, 53 and 73 years, were taking L-tryptophan for 2 months to 2 years, at 500, 1500, and 2250 mg d-1, respectively. All developed disabling myalgias, fatigue, and a variable skin rash, in association with marked eosinophilia. In one patient, symptoms and eosinophilia reappeared after rechallenge with L-tryptophan. Discontinuation of the drug resulted in gradual disappearance of the symptoms, signs and laboratory abnormalities in two patients. One patient was treated with corticosteroids because of persisting myalgias. Because of the non-specific clinical manifestations, clinicians from all subspecialties of internal medicine might be confronted with such patients and should be aware of this new entity.- - - - - - - - - - ranking = 5keywords = eosinophilia-myalgia syndrome, eosinophilia-myalgia (Clic here for more details about this article) |
3/26. plasmapheresis in a case of eosinophilia-myalgia syndrome with ascending polyneuropathy.eosinophilia-myalgia syndrome complicated by ascending polyneuropathy in a 40-year-old woman is described. High-dose intravenous steroids had no beneficial effect on the clinical course. Dramatic and rapid clinical improvement occurred with the use of plasmapheresis. The use of this therapeutic modality should be considered in patients with a similar clinical presentation.- - - - - - - - - - ranking = 4keywords = eosinophilia-myalgia syndrome, eosinophilia-myalgia (Clic here for more details about this article) |
4/26. Papular mucinosis in L-tryptophan-induced eosinophilia-myalgia syndrome.Five patients with the L-tryptophan-related eosinophilia-myalgia syndrome had a generalized eruption of flesh-colored papules. In all patients, histologic examination revealed a focal accumulation of mucin in the upper mid dermis, associated with increased dermal cellularity. The mucin was composed predominantly of hyaluronic acid, with small amounts of sulfated acid mucopolysaccharides. The cells within the lesion were fibroblasts. The lesions slowly regressed after L-tryptophan was discontinued. Proposed explanations for the L-tryptophan-related eosinophilia-myalgia syndrome have centered on contaminants, chemically related to L-tryptophan, introduced in the manufacturing process. tryptophan metabolites have been linked with sclerotic cutaneous diseases but have not been previously implicated in cutaneous mucinoses.- - - - - - - - - - ranking = 6keywords = eosinophilia-myalgia syndrome, eosinophilia-myalgia (Clic here for more details about this article) |
5/26. Acute eosinophilic pulmonary disease associated with the ingestion of L-tryptophan-containing products.A series of four patients with pulmonary infiltrates, pleural effusions, hypoxemia, peripheral eosinophilia, and symptoms of dyspnea, fatigue, and weakness is reported. lung tissue obtained in three patients revealed interstitial pneumonitis, small-to-medium-vessel mixed-cell vasculitis, and alveolar exudate of histiocytes and eosinophils. All patients reported ingestion of L-tryptophan-containing products at a time when an association between L-tryptophan and the eosinophilia-myalgia syndrome was established. This clinical pattern of pulmonary involvement may be part of the continuum of the eosinophilia-myalgia syndrome. The pathophysiology of this syndrome and the relationship with the ingestion of L-tryptophan-containing products have not yet been identified.- - - - - - - - - - ranking = 2keywords = eosinophilia-myalgia syndrome, eosinophilia-myalgia (Clic here for more details about this article) |
6/26. Pulmonary involvement in the eosinophilia-myalgia syndrome.We describe the cases of three women with pulmonary involvement in the eosinophilia-myalgia syndrome. The illness was characterized by elevated peripheral blood eosinophil counts, myalgias, fatigue, and dyspnea. Two of three patients had bilateral infiltrates on chest roentgenograms. All three had markedly decreased carbon monoxide diffusing capacities and pulmonary hypertension. High-dose prednisone therapy provided only partial resolution of the pulmonary symptoms. Open lung biopsy specimens showed chronic interstitial and perivascular infiltrates in two of the patients and moderate fibrointimal hyperplasia of pulmonary vasculature in the third. High-dose prednisone therapy prior to the biopsies may have modified the original histologic features.- - - - - - - - - - ranking = 5keywords = eosinophilia-myalgia syndrome, eosinophilia-myalgia (Clic here for more details about this article) |
7/26. eosinophilia-myalgia syndrome associated with ingestion of L-tryptophan: muscle biopsy findings in 4 patients.Muscle biopsies of 4 patients with the eosinophilia-myalgia syndrome associated with ingestion of L-tryptophan showed lymphocytic infiltrates with occasional eosinophils largely restricted to interstitial fibrous tissue and perivascular areas. There was inflammation and fibrosis of muscle spindle capsules in 3 patients. In the 2 sickest patients, there was profound muscle atrophy, affecting both muscle fiber types.- - - - - - - - - - ranking = 1keywords = eosinophilia-myalgia syndrome, eosinophilia-myalgia (Clic here for more details about this article) |
8/26. Neurologic complications of the tryptophan-associated eosinophilia-myalgia syndrome.A case of tryptophan-associated eosinophilia, central nervous system complications, and multiple white matter lesions by magnetic resonance imaging is presented. Eosinophilia regardless of its cause should be included within the differential of patients exhibiting periventricular white matter lesions.- - - - - - - - - - ranking = 4keywords = eosinophilia-myalgia syndrome, eosinophilia-myalgia (Clic here for more details about this article) |
9/26. Postmortem studies of the heart in three fatal cases of the eosinophilia-myalgia syndrome.OBJECTIVE: To examine the hearts of individuals who died from the eosinophilia-myalgia syndrome associated with ingestion of L-tryptophan, with particular attention paid to the coronary arteries, the neural structures, and the conduction system of the heart because of reported terminal disturbances of cardiac rhythm and conduction. STUDY MATERIAL: Three hearts fixed in neutral formalin and well preserved with all the relevant areas of conduction system intact. methods: light microscopic examination of subserial sections of the sinus node, atrioventricular node and His bundle, coronary chemoreceptor and regional nerves, ganglia, and small coronary arteries. Routine stains used were Goldner trichrome and Verhoeff-van Gieson. RESULTS: Arterial abnormalities were numerous and primarily of two types: focal fibromuscular dysplasia causing moderate to severe narrowing, as well as endarteritis and panarteritis. Extensive examples of neuritis and ganglionitis were present throughout the heart, including the conduction system, where arterial abnormalities were also abundant. In the coronary chemoreceptor there were both old and new lesions comprising focal inflammation with degeneration as well as older areas of fibrotic destruction. Within the sinus node, areas of dense fibrosis replaced all nodal tissue. These abnormalities were similar in nature and extent in all three hearts. CONCLUSIONS: The pathologic lesions present in the coronary arteries, neural structures, and conduction system of the heart in patients who died from the eosinophilia-myalgia syndrome provide a suitable anatomic substrate for substantial cardiac electrical instability, including the occurrence of sudden death. In cases of unexplained cardiac electrical instability or sudden unexpected death an inquiry should be made about previous use of L-tryptophan. In patients with the eosinophilia-myalgia syndrome, the possibility of cardiac electrical instability should be considered as part of long-range clinical management.- - - - - - - - - - ranking = 4.3308223090274keywords = eosinophilia-myalgia syndrome, eosinophilia-myalgia (Clic here for more details about this article) |
10/26. L-tryptophan use and the eosinophilia-myalgia syndrome.We present a case of the eosinophilia-myalgia syndrome in a patient taking large doses of L-tryptophan for sedation. He developed the now-classic findings of myalgias, skin changes, and marked eosinophilia. This syndrome was first recognized in late 1989, and epidemiologic studies have demonstrated an association of the clinical syndrome with ingestion of L-tryptophan. The mechanism of toxicity remains unknown. Casual use of L-tryptophan has been diminished by its rapid removal from the nutrition counter of health food stores.- - - - - - - - - - ranking = 5keywords = eosinophilia-myalgia syndrome, eosinophilia-myalgia (Clic here for more details about this article) |
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